Cancer Challenge in Hong Kong - The Way Forward · 2020-04-28 · Alice Ho Miu Ling Nethersole Charity Foundation Professor in Holistic Cancer Care, University of Hong Kong; Vice-Chairman,

Alice Ho Miu Ling Nethersole Charity Foundation Professor in Holistic Cancer Care,

University of Hong Kong;

Vice-Chairman, Hong Kong Anti-Cancer Society

Cancer Challenge in Hong Kong

- The Way Forward

CLINICAL ONCOLOGY

THE UNIVERSITY OF HONG KONG

THE UNIVERSITY OF HONG KONG - SHENZHEN HOSPITAL

1

Anne W.M. LEE

2

Goal set in the year 2011

↓ premature death 25%

by the year 2025

Non-Communicable Diseases

Cancer, diabetes, cardiovascular & chronic lung diseases

3

17 Global Goals set by United Nations in 2015

↓ 1/3 premature death due to NCD

by the year 2030

4

World Health Assembly: WHA 58.22 in 2005, WHA70.12 in 2017

0

5,000

10,000

15,000

20,000

25,000

No. o

f ca

se

s

Year

Male Female

5

Observed no. Projected no.

14,715

14,395

19,320

22,870

Seriousness of cancer burden in Hong Kong

Year 2015: 30,318 new cases & 14,316 deaths

(Top killer – 1/3 of all deaths)

Hong Kong Cancer Registry


APC = Annual Percent Change


APC = Annual Percent Change



Range among 185 countries: 0.09 to 0.74 (World 0.49)

Surrogate Indicator for 5-year Relative Survival

[1 – (Age-Standardized Mortality/Incidence)]

Hong Kong Cancer Registry 2015

Proxy relative survival by selected countries

Surrogate Indicator for 5-year Relative Survival

[1 – (Age-Standardized Mortality/Incidence)]

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8

Republic of Korea

Australia

Norway

United States of America

Ireland

Sweden

Canada

New Zealand

Finland

Italy

United Kingdom

Japan

Spain

Germany

Hong Kong (2015)

Singapore

Philippines

China

India

Viet Nam

Proxy RS (1 - ASM/ASI)

Hong Kong Cancer Registry 2015

Current Strategy & Action Plan by HKSAR

The Government has established Cancer Coordinating Committee (2001)

Report on cancer strategy was presented to Legislative Council (Mar 2018)

Describing current cancer statistics, primary prevention, screening, cancer

services, cancer registry & support for research.

The way forward - the Government will continue to implement current measures,

review local recommendations on prevention & screening. Hospital Authority is

developing a Strategic Service Framework for Cancer Service.

Waiting time from diagnosis to first treatment 90th percentile for patients in public hospitals (Jul 2016 - Jun 17)

80 days for colorectal cancer

66 days for breast cancer

54 days for nasopharyngeal cancer

Inadequacy (esp. on services for cancer patients)

× Scanty data on indicators for monitoring.

× No specific targets / actions

Current Strategy & Action Plan on NCD by HKSAR

Issued by Department of Health,

May 2018

Cancer-Related √ in line with WHO target

X Hong Kong – NO target (WHO – 80% availability)

√ √

√

√

x

Inadequacy

× No plan to fully

implement vaccination

against human

papillomavirus to

prevent cervical cancer

× No specific target on

diagnosis & treatment, &

no indicators for

monitoring.

13

14

Comprehensive Cancer Control Strategy & Action Plan

15

Priority Action for 2018 –

Pragmatic interventions for 3 most worrisome major cancers

1st

Colorectal cancer

• Rising incidence → Top commonest cancer (17% of all new cases)

• Survival inferior to other developed countries

• Late presentation – only 37% stage I-II at diagnosis (2015)

• Delay in access to definitive treatment - 80 days in HA (2016-17)

Launch of

screening

5-yr Net Survival

Colon Rectum

South Korea 2004 71.8 71.1

Australia 2006 70.7 71.0

Japan 1992 67.8 64.8

Canada 2007 67.0 66.8

Finland 2004 64.9 64.4

United States† 2001 64.9 64.1

United Kingdom 2006 60.0 62.5

Hong Kong 2016 56.4 58.0

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Priority Action for 2018

1st

Colorectal cancer

Existing provision Primary prevention (to be further enhanced)

Screening – Subsidy for all citizens aged 50-75 yr (in phases –

to be expedited)

Proposal to reduce delay for Treatment

Target -

to reduce the 90th percentile waiting time to ≤30 days

Action -

Increase services by Hospital Authority

Expand subsidy on public–private partnership (PPP) to cover

both essential investigations & definitive treatment

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2nd

Cervical cancer • Rising Incidence – ↑ 6% in 2015 compared with 2014

Average +0.3% annually in past 10 years

• Survival lower than other developed countries

• Primary prevention – Limited subsidy for HPV vaccination Girls from families under Working Family Allowance & School Textbook Assistance Schemes

Presentation - 32% stage I & 30% stage II at diagnosis (2015)

Cervical Screening Program

• Proportion of women registered with program - 21% (2017)

• Proportion screened within 3 years - 47% (2014/15)

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“Our challenge is to ensure

• All girls globally are vaccinated against HPV

• Every woman >30 screened & treated for pre-cancerous lesions

• Improve access to diagnosis & treatment of invasive cancers

• Ensure availability of palliative care for women who need it.”

World Health Assembly (WHA) in May 2018

Call by WHO Director-General

to end suffering by cervical cancer globally

“Now is the time for

Global Elimination of Cervical Cancer”

http://www.who.int/reproductivehealth/call-to-action-elimination-cervical-cancer/en/





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Existing Provision Screening – public service available for women aged 25-64 yr

(to be enhanced)

Proposals for Primary Prevention & Treatment

Prevention

• To subsidize HPV vaccination to all girls aged 9-13 years.

• To improve compliance to vaccination & screening –

enhance public education, targeted campaigns, proactive tracing

Access to Treatment

• To measure waiting time for access to treatment

• To set target towards ≤30 days.

2nd

Cervical cancer

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3rd

Liver cancer

• High mortality → 3rd commonest cancer deaths

• Universal poor treatment results:

Proxy survival (1 – age-standardized mortality/incidence) = 0.2

Annual % change over past 10 year

Male Female

Incidence -2.3% -2.3%

Mortality -2.8% -1.8%

Hong Kong initiated universal neonatal Hepatitis B vaccination since 1988

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3rd

Liver cancer

Existing provision Primary prevention

Proposal for early detection

To subsidize screening for high-risk cohorts (Hepatitis B/C or cirrhosis)

J Cancer Res Clin Oncol 2004

Half-yearly USG + serum AFP

↓HCC mortality by 37%

Current recommendations on Screening (2016)

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Recommendation on Long Term Comprehensive Cancer Control

Primary Prevention – Tobacco Use

Existing status

Overall daily smoking rate in Hong Kong - 10.5% (2015)

× Current tobacco tax - 67% of retailed price

Proposal on Tobacco

↑ tax to 75% as recommended by WHO

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Primary Prevention – Harmful Use of Alcohol

Proposal on Alcohol Use

To introduce alcohol taxation for untaxed categories

To restrict alcohol advertisement

× Current alcohol tax – 0 if alcoholic strength <30%

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Existing provision -

Highly curable by radiotherapy ± chemotherapy (>95% if stage I)

× Late presentation – 19% stage I-II at diagnosis (2015)

× Waiting time for definitive treatment – 54 days

Screening – Nasopharyngeal Cancer

Survival by stage

Overa

ll surv

ival ra

te (

%)

Patients Stage I Stage IV

Screening-detected 41% 6%

General referral 1% 40%


To subsidize screening for high-risk cohorts (Family member of NPC pt.)

2 4 6 8 10 12 14 Year

0

20

40

60

80

100

Screening-detected

General referral

5-yr Survival 92% vs 70%

Improvement by screening

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Existing provision - Presentation – 74% stage I-II at diagnosis (2015)

× Waiting time for definitive treatment – 66 days

× Survival slightly lower than other developed countries

Screening – Breast Cancer


To subsidize screening for high-risk cohorts (BRCA gene mutation / family

of breast + ovary cancer)

Launch

screening

Net Survival

Breast

United States† 1995 90.2

Australia 1991 89.5

Japan 1977 89.4

Finland 1987 88.5

Canada 1988 88.2

South Korea 1999 86.6

United Kingdom 1988 85.6

Hong Kong - 83.3

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Early Detection - All Cancers

? Delay by patient in seeking medical advice – scanty data

Proposal

To enhance public education - symptoms of common cancers

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Accessibility to Diagnosis and Treatment

Delay in access to public services

• ? Diagnosis - no data

• Treatment – data on colorectal, breast & nasopharyngeal cancers only

Proposal

To monitor waiting time for all cancers

Targets: to work towards reducing waiting time (90th percentile) to ≤30 days

• from 1st suggestive symptom to definitive diagnosis

• from diagnosis to 1st definitive treatment

Hospital Authority - improvement / expansion actions

Advanced planning on manpower, hospital infrastructure & equipment

Public–private partnership - expansion of subsidy to cover both essential

investigations & treatment

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Affordability of Expensive Cancer Treatment

× Financial hardship All essential medicine (by WHO) are available in public hospitals

But many expensive items are categorized as self-finalized items

Subsidy limited to those eligible for Samaritan & Community Care Funds

Heavy financial burden for vast majority of middle-class citizens

Proposal

To steadily increase the scope of coverage for expensive treatment

To enforce health insurance coverage for cancer treatment

To consider tax deductions for cancer treatment

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Palliative Care / Holistic Care for Cancer Survivors/Carers

× Inadequate psychosocial support by public institutes • Rising prevalence of cancer survivors, many have persistent impairments

• Active rehabilitation needed to regain maximum functional capability

• For patients with incurable cancer - ↑ need palliative / end-of-life care

• Essential drugs for pain & symptom relief are available in public hospitals

• Psychosocial/spiritual support mainly by NGOs on a self-financing basis

× No analyses on unmet needs of patients & carers.

Proposal

To analyze unmet needs of cancer patients/survivors & carers

To set up a Cancer Foundation to support NGO Supplement public services to enhance

holistic care, palliative/hospice care, psychosocial/spiritual support

for patients & families

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Existing provision - Hong Kong Cancer Registry Completeness of registration - reckoned to be 97%

Data quality - rated as reaching highest standard

Surveillance on Cancer Control

• Laborious efforts - Lag time of 3 years for reporting

• Limited data on net survival & stage distribution

Proposal for Improving cancer surveillance

Mandatory reporting of newly diagnosed cancer

Prospective data on net survival & stage - at least top 10 cancers

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Primary Prevention

To subsidize a population-wide HPV vaccination to all girls aged 9-

13 years.

To further increase in tobacco taxation to 75% as recommended

by WHO

To introduce alcohol taxation for currently untaxed categories & to

restrict alcohol advertisement.

Early detection

To expedite the implementation of the colorectal screening

program

To subsidize regular screening for high risk cohorts of liver,

nasopharyngeal & breast cancers

Proposal for Chief Executive Policy Address

Summary of Key Targets & Actions

32



Accessibility to Diagnosis & Treatment

To work towards reducing waiting time to ≤30 days

from 1st suggestive symptom to definitive diagnosis

from diagnosis to 1st definitive treatment

through

Increase services by Hospital Authority

Expansion of subsidy on public–private partnership

Advanced planning on manpower, hospital infrastructure

& equipment

Access to Expensive Cancer Treatment

To increase the scope of coverage by Hospital Authority &

charity funds

To enforce health insurance coverage for cancer treatment

To consider tax deductions for cancer treatment

33



Palliative Care / Holistic Care for Cancer Survivors & Carers

To analyze unmet needs of cancer patients/survivors & carers

To set up a Cancer Foundation to support Non-Government

Organizations to supplement public services for enhancing

holistic care, palliative/hospice care, psychosocial/spiritual

support for patients & families

Surveillance on Cancer Control

To consider mandatory reporting of newly diagnosed cancer

To provide data on net survival & stage distribution for at

least top 10 cancers.

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Cancer-related NGOs 1. The Hong Kong Anti-Cancer Society

2. Hong Kong Cancer Fund

3. Society for the Promotion of Hospice Care

4. Children’s Cancer Foundation

5. World Cancer Research Fund (Hong Kong)

6. Asian Fund for Cancer Research

7. Tai Shan Charitable Association

8. YOT Chong Sok Un Medical Fund (cancer aid) Company

9. Pau Kwong Wun Charitable Foundation

10. Hong Kong Christian Cancer Care Association

11. Hand in Hand Cancer Foundation

12. Maggi’s Cancer Caring Centre

13. The Cancer Crusade Angels Cancer Service Society of HK

14. Hong Kong Society of Clinical Oncology

15. The Hong Kong Cancer Therapy Society

16. Hong Kong Breast Cancer Foundation

17. Hereditary Breast Cancer Foundation

18. Hong Kong Breast Oncology Group

19. CUHK Jockey Club Bowel Cancer Education Centre

20. Hereditary Gastrointestinal Cancer Registry

21. HK Liver Cancer &Gastrointestinal Cancer Foundation

22. Hong Kong Prostate Foundation

23. Hong Kong Society of URO-Oncology

24. Hong Kong Blood Cancer Foundation

Stakeholders in the Fight against Cancer in HK

Leader: Chief Executive, Hong Kong Government

• Finance

• Social Welfare

• Education

Private Partners

Bureau for Food & Health

Government Bureau/Departments

• Department of Health

• Hospital Authority

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Cancer touches almost every family Enormous economic burden & loss of productive life

Hong Kong must Invest in Health!

Comprehensive cancer control planning

is essential for

most cost-effective actions to ↓ cancer mortality

Concerted efforts by all stakeholders

Fight to Reduce Cancer Mortality

Documents

Cancer Challenge in Hong Kong - The Way Forward · 2020-04-28 · Alice Ho Miu Ling Nethersole Charity Foundation Professor in Holistic Cancer Care, University of Hong Kong; Vice-Chairman,